Everybody in the United States knows that there are problems with our health care system. They say that while the quality of care is excellent for anyone able to obtain it, there are too many poor and uninsured who cannot get access to care. They also complain about our infant mortality rates and life-expectancy, saying that both are lower than the numbers cited in other modern countries. Then they point to the European, Canadian, and Japanese social welfare systems and proclaim that the only way to truly provide for our future and our children is to implement a similar system in the United States.

But aside from the oft-debated questions of whether it’s moral to take from some in order to give to others (it’s not) or if the oft-touted statistics referred to above really tell the whole tale (they don’t), there is one question of crucial importance to our children and our future that never seems to get asked: “Is a public welfare state sustainable in the long-term?”

As far as I can tell, the answer is “No.”

There are a lot of economic arguments that could be made as to why that is, but this article will concentrate on only two:

• Europe, Canada, and Japan are all deeply in debt, at a level either on par with or exceeding that of the United States;
• Europe, Canada, and Japan are all reproducing at below replacement level.

Now, the United States certainly owes a lot of money to a lot of people, but there are actually many other modern countries that owe a lot more. The United States gets touted around the most because it’s the biggest fish and because the absolute amount of money involved is so large, but when you look at it from a more normalized perspective, the numbers tell a different tale. These values combine the public (domestic) and external (foreign) debt as a percentage of the country’s Gross Domestic Product (GDP):

As this list shows, of the countries we are supposedly supposed to emulate only Canada and Australia have lower levels of debt than the US. But not only is 120-125% of GDP not exactly bragging material, they’re not even funding a war or paying for the upkeep of a military presence in 130 separate countries (again, not a typo). Australia isn’t even funding that much more of a social welfare state than we are. Additionally, I am willing to bet that we will see those debt levels go up in the not-too-distant future as their populations age and demand their health-care “rights,” but their supply of young people able and willing to pay those health care bills starts to dwindle.

Which leads to the second portion of the argument. The US debt level may be high, our grandchildren may well end up cursing our names for getting them in this mess, but at least the United States can expect to have grandchildren. By some odd coincidence though, it seems that every single country whose welfare system is commonly touted as superior to ours is failing to reproduce at replacement level. Remember that replacement level is approximately 2.1 children/woman, the extra 0.1 being to replace random attrition among the population:

In short, whatever these other countries might be saying about providing for their children, the United States is apparently the only major modern country in the world that considers actually having children to be a worthwhile endeavor.

Now let’s ask ourselves some questions about whether all this is really for the children. If Europe, Canada, and Japan were creating these public systems for the sake of their children, would they really be mortgaging their countries’ economies (and with them, their children’s futures) in order to do it? Would they really be failing the replacement test so abysmally? And do you really think that a single government amongst the countries listed above isn’t aware of what is happening?

So for those of you who still insist that you want to institute universal care and the welfare state for the sake of our children, all I have left to say to you is just one word:

10 Responses to “For the … Children?”

I also get tired of hearing the standard justifications for the health care programs now being promoted. “Taking care of our children” is among the worst, and the most hypocritical. While it’s true that health care costs and access are important problems that need to be addressed, bankrupting the country is a good deal more important, especially for our children.

When the whole picture is considered — the massive bailouts, cap-and-trade, health care reform — I have to ask myself if there are any adults involved in government. Any fool can see that absent a willingness to pay the bills, we can’t afford any of this. Except maybe the fools in Washington.

One side note: When “they say: too many poor and uninsured . . . cannot get access to care” it’s not exactly accurate. My understanding is that anyone — citizen or not — can get care in any hospital emergency room, even for a common cold; they can’t turn anyone away.

Unfortunately for all of those countries, it is the USD that keeps them from spinning off into the void. The world’s faith in the USD is presently waning (justifiably, I might add), and I do not look for it to wax any time soon, if at all.

“But aside from the oft-debated questions of whether it’s moral to take from some in order to give to others (it’s not)”

Well gosh, someone should tell THAT to the insurance companies who take money from people and pocket it, then refuse to pay for medical care their clients need. America RUNS on the redistribution of wealth. It just redistributes wealth from people who have little to people who have lots. As we are seeing, that’s fun for the people on top … until the whole system comes crashing down due to an eroded foundation.

Harvey, anyone can be seen in an ER by a physician. If the condition that brought them to the ER is neither emergent nor urgent (like a cold), they will not be treated and will generally be told to make an appointment with their PCP and sent on their way. And if you think about it, that is what should happen. They aren’t called EMERGENCY rooms because it sounds catchy.

If it is an urgent condition (say, a laceration requiring stitches) that needs a physician, physician’s assistant, or nurse practitioner to tend it, they’ll also get a scrip for a mild narcotic and an antibiotic and be told to follow up with their PCP.

Elizabeth, in states where the Insurance Commissioner actually does his/her job, insurance companies that make a habit of doing that are generally shown the door. That very thing happened in Texas about 10 years ago. Off the top of my head, about 180 or 190 insurance companies were told they could no longer do business down here.

It’s kind of a double-edged sword, though, for when competition is reduced, prices almost always go up.

Elizabeth, you make an excellent point. The purpose of businesses is to sell the cheapest product at the highest price. Nothing wrong with that; that’s how profit is made. It’s the consumer, acting in his own self-interest, who keeps that process under control — the product can’t be too shoddy or too expensive, or he won’t buy it. That’s the invisible hand at work.

Despite the theory, health insurance companies, like a lot of other businesses, have an unfair advantage. They sell coverage based on complex contracts that most clients can’t understand, then refuse payment if they can. And yes, it is a form of redistribution, but then so is all of life, if you think about it.

Brian’s example of how this is controlled is an example of regulation working well in defense of consumers. That’s how it should be, too. But if health care were covered by a single-payer (that’s a euphemism for “government”), there would be no one to regulate them and control quality. They could do whatever they please.

One of the problems with people being uninsured is that they go to ERs for what should be a physician visit. Federal law says they have to be treated, but then they usually receive a bill (assuming they gave correct identity information). If for no other reason, having everyone insured would at least let ERs go back to treating true emergencies.

“Well gosh, someone should tell THAT to the insurance companies who take money from people and pocket it, then refuse to pay for medical care their clients need.”

Someone should also tell it to governments that proclaim they can solve the problems of the people by progressive taxation and government bailout plans. Someone should also point out that our current insurance system is a result of bad government tax policy and government regulations that dampen the effects of the free market by restricting competition across state lines.

You can’t solve a core problem by meddling with the symptoms. You can’t manipulate causes by attempting to control the effects. And you can’t create a strong economy or health care system by simply throwing money into the country and mandating that everyone shall have access to health care or else.

Elizabeth – I also wish you’d actually discussed the core point of my article instead of nit-picking on a single sentence which had nothing to do with the actual subject under debate, which was: Are universal care and the welfare state sustainable in the long term?

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